Measuring Empowerment Counselling in Routine Primary Health Care: Psychometric Properties of a Portuguese Adaptation of the Empowering Speech Practices Scale.

PURPOSE: Empowerment is a widely accepted approach to health promotion in which primary care nurses play an important role. Despite its clinical importance, empirical knowledge is low, mainly due to the lack of instruments to measure this construct. The Empowering Speech Practices Scale (ESPS) is a Finnish measure used to assess the empowerment process in counselling sessions. We designed this study to assess the psychometric properties of a Portuguese adaptation of the ESPS for families of 5-year-old children and nurses in well-child visits. DESIGN AND METHODS: We used a cross-sectional survey design. The ESPS was translated and adapted to the context of children and family health promotion. We administered a sociodemographic questionnaire and the Portuguese ESPS to a sample of 82 families attending a 5-year-old well-child visit and 25 primary care nurses in Portugal. We evaluated the Portuguese ESPS for construct validity and internal consistency. RESULTS: Exploratory factor analysis supported a 44-item scale, two-component model, which is similar to the original version, explaining 73.79% of the total variance. Each subscale presented excellent internal consistency and distinguished consultations conducted by nurses with academic training in empowerment patient education. CONCLUSIONS AND IMPLICATIONS: The Portuguese ESPS is a valid and reliable instrument for assessing empowerment in health counselling with families in well-child visits. It looks at the process from two perspectives: the nurses' and the families' perspectives. It can be useful to evaluate quality of care, to identify areas of improvement, and to delve deeper into relationships between empowerment and health outcomes.

Two sides of the same well-child visit: Analysis of nurses' and families' perspectives on empowerment in health counselling.

AIMS: To explore the degree of empowering health counselling in well-child visits, considering nurse and family perspectives and to examine its associated factors. BACKGROUND: Empowerment has gained high priority in the world health strategy, being claimed for its benefits for people's health and well-being. DESIGN: The design includes an exploratory cross-sectional, correlational study. METHODS: We collected data between January 2018-October 2019 from a convenience sample of 82 families attending a 5-year-old well-child visit and 25 nurses at Portuguese health centres. Families and nurses assessed the same counselling session using parallel statements of the Portuguese Empowering Speech Practice Scale, grouped in two subscales (nurses' action and families' action). Questionnaires also included the Parent's Longitudinal Continuity in Primary Care scale, the Family Nutrition and Physical Activity tool and anthropometric and sociodemographic questions. We employed descriptive statistics, paired-samples t-test, analysis of variance and regression analysis. RESULTS: Both nurses and families reported that empowerment had been practiced in high degree. The most practiced elements were those from nurses' action subscale (e.g. constructing a positive atmosphere) and the least practiced were from families' action (e.g. disclosure). A discrepancy between nurses' and families' ratings were found for individualized information and advice, disclosure and asking questions, with families reporting higher scores. Nurses' formal training in empowerment and obesity was associated with higher scores on the nurses' action subscale. The families' limited experience with a regular health centre and nurse and families having children with overweight were both associated with lower scores on the two subscales. CONCLUSIONS: Although the positive experience by nurses and families is an important finding, the reasons for the differences in perceptions of empowerment require further research. IMPACT: The Portuguese Empowering Speech Practice Scale can be a useful tool to evaluate services, both from professionals' and families' perspectives and to identify areas of improvement.

Examining Empowerment Interventions With Families and Preschool Children: Systematic Review of Randomized Controlled Trials.

Empowerment is a core construct in health behavior and an emerging trend in pediatrics. Although it has been suggested as an approach that may promote the person's participation in health care decisions and positive outcomes, little is known about the nature and effectiveness of interventions to support empowerment in families and preschool-age children. The aim of this review is to identify, appraise, and synthesize the evidence on health interventions explicitly using empowerment as an orienting concept with families and their preschool-age children. We identified randomized controlled trials (RCTs) through systematic searches of eight databases for articles published between 1986 and January 2019 and included RCTs that addressed empowerment as a health intervention approach or outcome and that studied families with 3- to 5-year-old children. The application of empowerment theory, the family and child involvement, and the use of behavior change techniques (BCTs) were assessed through appropriate frameworks. Ten interventions were identified, and 50% of them showed positive outcomes. Most studies claimed a theoretical base. However, the studies provided limited details on theory application in intervention planning, implementation, and evaluation, and the children's involvement in the interventions was generally scarce. The most commonly applied BCT was "instruction in how to perform the behavior." We identified 16 potentially effective BCTs. The evidence was not sufficiently robust to determine the effectiveness of empowerment interventions with families and preschool-age children. Additional high-quality studies are needed to produce clearer conclusions. Our results are useful for the design and evaluation of future interventions.